Bipolar Disorder and Substance Abuse

Posted in Dual Diagnosis on July 30, 2012
Last modified on April 20th, 2019

Bipolar disorder, a serious psychiatric condition sometimes referred to as “Manic Depression”, is aptly named due to the “bipolar opposite” of the extreme moods. Most individuals with bipolar disorder experience mood swings that range from extreme manic highs to severely depressed lows. The disorder can be diagnosed after just one manic episode and no depressive episodes, although most have both.

Many people with bipolar disorder can be quite successfully treated with a combination medication and psychotherapy. However, due to the challenging nature of this disorder it is not uncommon for bipolar individuals to attempt to alleviate symptoms by self-medicating. They may self-medicate either in place of or in spite of traditional treatment.
The frequency with which individuals who have bipolar disorder also suffer from substance abuse is very high. In fact, it leaves little doubt that there is a link between the two although it is not yet known which condition leads to the other. It is estimated that approximately 60% of all individuals with bipolar disorder also abuse substances.[1] When both conditions are seen in an individual it can lead to three different types of complications. These include:

Problems in diagnosing the bipolar disorder

The substance mimics the symptoms of bipolar disorder (e.g. severe mood swings) leading to a misdiagnosis

The substance has adverse effects on the treatment for the bipolar disorder

Causes of Substance Abuse Disorders in Bipolar Individuals

It’s not surprise that individuals with bipolar disorder often feel the need to self-medicate their symptoms. It’s often the only way they can function more normally. Additionally, some of the symptoms of this troubling disorder also increase the potential for self-medicating. These include the poor judgment and impulsive behavior that are characteristic during a hypomanic or manic phase. Also, during a manic episode they tend to engage in highly pleasurable activities that may include indulging in drug and alcohol abuse for recreation.

In some cases, individuals who end up developing bipolar disorder have a substance use disorder prior to the first appearance of their bipolar symptoms. The potential for the bipolar disorder may already exist, but it doesn’t manifest until after the substance abuse has already been occurring. Unfortunately, any time both disorders are present, the symptoms of bipolar disorder will worsen and treatment becomes less effective – if it is sought at all.
As mentioned previously, some individuals with bipolar disorder experience only episodes of mania and not those of depression. These individuals, as well as men who have the disorder, have a greater risk substance abuse and alcoholism than other bipolar individuals.[1]

Complications in Diagnosis

When bipolar disorder manifests in an individual, they may start to feel periods of depression that alternate with periods of mania. They often have difficulty functioning during the depressed episodes because of their lack of energy, sleep problems, and feelings of apathy – all symptoms typical of depression. It’s not uncommon for someone in this phase to seek stimulant drugs that will give them more energy. Cocaine and amphetamines are frequently used to improve energy levels and help them feel more alert. The goal is often to help them remain functional enough to perform at their job and manage other responsibilities.

Although alcohol is a depressant, bipolar individuals may use it along with other depressants, such as pain pills, because of their feelings of depression. These drugs can temporarily give them relief from the pain, anxiety, and insomnia that are often present during this phase of the disorder. Anything that numbs or reduces the depressive symptoms is welcome.

When the bipolar individual is already using these substances to self-medicate before a substance disorder diagnosis is made, the effects of the alcohol or drugs may be incorrectly attributed to the bipolar disorder. Any substance that changes the behavior or mood of the individual can produce symptoms that are similar to those of bipolar disorder. Depending on the presentation and accuracy of the history provided, the patient’s physician may not realize that an underlying substance disorder is the primary cause.

Most drugs are either stimulants or depressants. In other words, they either cause the individual to experience calmer moods or increase their energy levels and make them feel happier. An evaluation of the patient may result in a diagnosis of substance abuse and/or alcoholism without any considering the possibility that of a substance disorder. A thorough history and a drug screening will help ensure a more accurate diagnosis.

A significant percentage of people who have undiagnosed bipolar disorder and self-medicate with drugs or alcohol end up without an accurate diagnosis. As a result, they don’t receive the treatment they need. This is the reason that many people finally end up getting an accurate diagnosis once they become clean and sober. The bipolar symptoms finally become evident. However, without treatment they will often end up relapsing as they resort to self-medicating once again.

Treatment Issues

When individuals with bipolar disorder use alcohol or drugs while taking medication for their disorder, the effects of the substances can interfere with the medication’s effectiveness. The main medications used for bipolar disorder are mood stabilizers, such as Depakote or Lithium. Antipsychotic medications like Zyprexa may also be used to help reduce symptoms. These medication help stabilize the brain chemicals. This helps prevent the occurrence of mania .

However, this delicate balance of the chemicals in the brain can be disrupted by alcohol and drugs, causing a manic or depressive episode even though the person is on medication. It is important to keep in mind that treatment for bipolar disorder is primarily a way to manage the symptoms. It often fails to treat the condition itself. Drugs and alcohol can worsen symptoms and make the condition more of a problem instead of alleviating it.

The Argument for Dual Diagnosis

Since there is such an obvious link between psychiatric disorders, like bipolar disorder, and substance abuse, there are many facilities today that offer dual diagnosis treatment. Dual diagnosis is for individuals who have a substance disorder as well as a psychiatric disorder. Experts have recognized that in order for treatment to be effective, both disorders need to be addressed.

Dual diagnosis programs will look at all the symptoms of the individual, along with their medical and family history. This helps them determine if there is a single cause of their symptoms or if they have both a mental disorder, such as bipolar disorder, and a substance abuse problem as well.

In order for these individuals to have a healthy, normal life, they must be treated for both conditions individually. A dual diagnosis center will give them the treatment options they need while also giving them the advantage of receiving all forms of treatment in the same setting. Diagnosis is an important first step in recognizing the real problem and creating an appropriate treatment plan.

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